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  • Title: Off-pump coronary artery bypass grafting improves in-hospital mortality in patients with dialysis-dependent renal failure.
    Author: Zhang L, Boyce SW, Hill PC, Sun X, Lee A, Haile E, Garcia JM, Corso PJ.
    Journal: Cardiovasc Revasc Med; 2009; 10(1):12-6. PubMed ID: 19159849.
    Abstract:
    OBJECTIVE: Patients with chronic dialysis-dependent end-stage renal disease are increasingly referred for coronary artery bypass grafting (CABG) and their early outcome is less favorable. Off-pump CABG (OPCAB) has achieved encouraging results in high-risk patients. Therefore, we designed this retrospective study to test the hypothesis that OPCAB reduced surgical risks in dialysis patients. METHODS: From January 2000 to December 2005, 294 dialysis-dependent patients received isolated CABG at the Washington Hospital Center. Among them, 168 underwent OPCAB (off-pump group), and 126, CABG with cardiopulmonary bypass (CPB) (on-pump group). The in-hospital outcomes were analyzed. RESULTS: The two groups were comparable in terms of preoperative characteristics. The Parsonnet's Bedside Score of the off-pump group was similar to that of the on-pump group (32.0 vs. 32.0, P=.57). The in-hospital mortality of the off-pump group was significantly lower than that of the on-pump group (5.4% vs. 11.9%, P=.04). Although the percentage of patients who received transfusions was similar, the on-pump group received more total transfusions. Logistic regression analysis revealed that use of CPB independently predicted in-hospital mortality [odds ratio (OR), 5.0; 95% confidence interval, 1.78-13.85; P<.01] and perioperative myocardial infarction (MI; OR, 5.1; 95% confidence interval, 1.18-22.40; P=.03). No significant difference in long-term survival at 4 years was absorbed between the two groups of hospital survivors. CONCLUSIONS: Our data suggest that OPCAB is a safe alternative to on-pump CABG in dialysis patients. Avoiding CPB resulted in less perioperative blood utilization, MI, and hospital mortality.
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